消化系统诊断学部分的PPT整理：使用说明：1、略去了PPT中的图片，但是文字部分全部保留。
顺序同PPT。
2、PPT上有字体颜色区别，这份word版上没有和它对应，基本都是黑字。
3、中文系本人参照大绿书手工翻译，个别地方在内容上稍作了补充，仅供参考。
Abnormal Abdominal Findings and Their Respective Differentiation--- Ascites腹部异常发现及其鉴别---腹水1、Definition of Ascites 腹水的定义free fluid accumulation within the abdominal cavity 腹腔内游离液体积聚little free fluid within the abdominal cavity in normal cases正常情况下腹腔内也有少量游离液体the amount of free fluid is less than 200 ml接上一条，不超过200mlexcessive free fluid accumulates within the abdominal cavity --- ascites腹腔内积聚过量液体即称为腹水2.Etiology of ascites 引起腹水的病因Cardiovascular Diseases 心血管系统疾病√ congestive heart failure 充血性心力衰竭√ pericarditis(心包炎)√ pericardiac tamponade(心包压塞)√ obstruction of inferior vena cava 下腔静脉梗阻Hepatic and Portal System Diseases 肝脏及门脉系统疾病√ hepatic cirrhosis 肝硬化√ hepatic carcinoma 肝癌√ inflammation of portal vein and the formation of its thrombosis门静脉炎和门脉血栓形成√ rupture of hepatic abscess the most common agents responsible for ascites 肝脓肿破裂是引起腹水的最常见病因。
Renal diseases 肾脏疾病√ glomerulonephritis(肾小球肾炎),√ Nephrotic tubule disease 肾小管病变√ renal carcinoma 肾癌Peritoneal Disease 腹膜疾病√ peritonitis 腹膜炎√ malignant peritoneal tumor 腹膜恶性肿瘤（绝大多数为继发性肿瘤）In China, tuberculose peritonitis is very common.在中国，结核性腹膜炎较为常见。
Inadequate nutrition 营养缺乏√ edema caused by hypoalbuminemia 低蛋白性水肿√ deficiency of Vitamin B1维生素B1缺乏Lymphatic system diseases 淋巴系统疾病√ filariasis(丝虫病)√ lymphoma within abdominal cavity 腹腔淋巴瘤√ the obstruction of thoracic duct(胸导管梗阻) or cisterna chyli (乳糜池梗阻)Female reproductive system diseases 女性生殖系统疾病√the rupture of Fallopian tube(输卵管) caused by ectopic pregnancy/ extra - uterine pregnancy 异位妊娠/宫外孕引起的输卵管破裂（大绿书：宫外孕破裂）√ tumors of female reproductive system女性生殖系统肿瘤Rupture of abdominal viscera 腹腔脏器破裂√ rupture of stomach, bowel, liver, spleen, or gallbladder胃肠肝脾胆囊破裂Miscellaneous 其它√ myxedema(粘液性水肿)√ Meigs syndrome Meigs综合征Meigs syndrome 卵巢纤维瘤伴有腹水和（或）胸水√ the triad(三联症) of benign ovarian fibroma (良性卵巢纤维瘤) with ascites and pleural effusion胸水√ resolves after resection of the tumor 肿瘤切除后治愈3.Pathogenesis of ascites 腹水的发生机制similar to the pathogenesis of edema (Alteration of Starling forces)与产生水肿的各种机制相似√ increased hydrostatic pressure 液体静水压增加√ decreased plasma colloid oncotic pressure 血浆胶体渗透压下降√ impediment of lymphatic circulation 淋巴循环受阻√ renal factors肾脏因素4.To determine whether there is ascites or not？诊断胸水Question: What are the probable signs which may indicate ascites?腹水的体征有哪些？5.Inspection 视诊√a large amount of free fluid within the abdomen --- abdominal wall can be lax in supine position, fluid can deposit at both lateral sides腹腔内有大量游离液体---仰卧位时，腹壁松弛，液体沉积于两侧肋腹部√ the contour just like a frog belly蛙腹√ lies on one side or sits, the lower part of abdominal wall will be bulged, as from the movement of free fluid. 患者侧卧位或坐位时，下份腹壁膨隆，因为游离液体向下移动了√ long-term ascites --- the appearance of the umbilicus is protruded or everted (umbilical hernia).长期腹水—脐突出，或者外翻（脐疝）。
6.Auscultation --- Puddle test 听诊Puddle test (水坑试验) positive in elbow-knee position 肘膝位--- at least 120 ml free fluid in abdominal cavity腹腔内至少有120ml游离液体才能用此法检查到7.Percussion --- shifting dullness 叩诊---移动性浊音A volume of free fluid in the peritoneal cavity greater than 1000ml can be detectedwith this method.腹腔内至少有1000ml游离液体才能用此法检查到Elbow-knee position 肘膝位--- puddle test 水坑试验The puddle test can detect as little as 120 mL of fluid腹腔内至少有120ml游离液体才能用此法检查到8.Palpation --- Fluid wave thrill (液波震颤)present only when there is a reasonably large amount of fluid, usually 3000-4000 ml只有当腹腔内有大量游离液体时（通常为3000~4000ml之间），才能看到液波震颤。
9.Differentiation from abdominal bulge 与腹部膨隆鉴别Overly obesity 过度肥胖√ very fat, with thick layer of abdominal wall 十分肥胖，腹壁脂肪厚√ obvious inversion of umbilicus脐凹明显√ without shifting dullness没有移动性浊音Huge ovarian cyst 巨大卵巢囊肿√ a large area of dullness at midabdomen浊音区在腹中部√ tympany at laterals (bowels could be pushed to the bilateral flanks)鼓音在两侧腹部（肠管被推到了两侧肋腹部）√ The dullness of ovarian cyst could not shift.卵巢囊肿产生的浊音不移动Ruler pressing test 尺压试验√ to differentiate huge ovarian cyst from real ascites 用于鉴别巨大卵巢囊肿和真正的腹水√ take the supine position, a hard ruler on the patient’s abdominal wall horizontally, presses the ruler downward with two hands患者仰卧位，用一硬尺横置于患者腹壁上，检查者双手向下按压硬尺If huge ovarian cyst exists, the pulsation of abdominal aorta will conduct to the rulervia the cyst, leading to rhythmic pulsation of the hard ruler.如果存在巨大卵巢囊肿，腹主动脉的搏动可经囊肿传导至硬尺，让硬尺随腹主动脉呈节律性搏动If free fluid, not cyst, exists in the abdominal cavity, the pulsation of abdominal aortacould not conduct, so the hard ruler has no such rhythmic pulsation.如果腹腔内为游离液体，而非囊肿，则腹主动脉的搏动不能被传导，硬尺不会出现上述的节律性搏动。